Organization
ENSEMBLE MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAVER T SHATTUCK M.D. (PRESIDENT)
(865) 633-9068
Entity
Organization
Contact information
Practice address
417 HOLLY ST, KNOXVILLE, TN 37917-7815
(865) 633-9068
(865) 246-2106
Mailing address
PO BOX 5777, MARYVILLE, TN 37802-5777
(865) 246-2104
(865) 246-2106
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/25/2017
Last updated
06/20/2017
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